• Rogelio A Coronado, Jacquelyn S Pennings, Hiral Master, Carrie E Brintz, Keith R Cole, Joseph Helmy, Emily R Oleisky, Claudia Davidson, Amir M Abtahi, Byron F Stephens, and Kristin R Archer.
• Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
• Spine. 2024 Oct 1; 49 (19): 133913471339-1347.

Study DesignRetrospective analysis of prospectively collected data.ObjectiveTo examine the combined influence of preoperative sleep disturbance and depression on 12-month patient-reported outcomes after lumbar spine surgery (LSS).Summary Of Background DataPsychological and behavioral factors are considered major risk factors for poor outcomes after LSS. However, there is a need to explore the combined effects of preoperative factors such as sleep disturbance and depression. Understanding the influence of sleep disturbance and depression can inform evidence-based preoperative assessment and shared-decision making of preoperative and postoperative treatment.MethodsData from 700 patients undergoing LSS were analyzed. Preoperative sleep disturbance and depression were assessed with PROMIS subscales. Established thresholds defined patients with moderate/severe symptoms. Outcomes for disability (Oswestry Disability Index) and back and leg pain (Numeric Rating Scales) were assessed preoperatively and at 12 months. Separate multivariable linear regressions examined the influence of each factor on 12-month outcomes with and without accounting for the other and in combination as a 4-level variable: (1) moderate/severe sleep disturbance alone, (2) moderate/severe depression alone, (3) both moderate/severe sleep disturbance and depression, (4) no moderate/severe sleep disturbance or depression.ResultsPreoperative sleep disturbance and depression were associated with 12-month disability and pain ( P <0.05). After accounting for depression, preoperative sleep disturbance remained associated with disability, while preoperative depression adjusting for sleep disturbance remained associated with all outcomes ( P <0.05). Patients reporting both moderate/severe sleep disturbance and moderate/severe depression had 12.6 points higher disability and 1.5 points higher back and leg pain compared with patients without moderate/severe sleep disturbance or depression.ConclusionsThe combination of sleep disturbance and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe sleep disturbance and depression could benefit from targeted treatment strategies.Level Of EvidenceLevel II.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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